Sunday, June 19, 2005

Prescriptions

I'm glad that Orac took on (and on) RFK, Jr.'s piece on thimerosal. I have no dog in that fight, and I'm inclined to side with Orac on the lack of evidence for an autism/thimerosal link.

In talking with my parents, I came up with something that's worth pointing out.

Even though the only reason many people care about this any more is that evidence of a link will let someone sue someone else, there are other reasons to be interested in what RFK, Jr. reported.

RFK repeated evidence of a link that has been debunked, or at best remains equivocal. He failed to report that the bulk of studies fail to show any connection. He failed to disclose conflicts of interest by advocates of the link (they earn a living as expert witnesses in autism lawsuits).

He also reported a string of meetings between industry reps, scientists, and federal regulators to discuss the link, the disposition of the data itself, and how to handle the media response to any evidence of a link.

Orac has shown how the more inflammatory quotes are not nearly as scary in context, and points out that most of the discussion is fairly serious and academic.

All that is good evidence that things were handled as they should have been. The problem arises from the fact that this meeting looks pretty suspicious even to a skeptic. I think that there's a case to be made for having private meetings like these, but there's a lot more to be said for a public process.

WIthin the last year, Celebrex and Vioxx have been pulled from the market over evidence that they can cause serious heart problems, evidence the manufacturers appear to have been aware of and suppressed. In the midst of suppression of climate change researchat the behest of ExxonMobil, and the host of other entanglements between scientific data, industry interests, and the politicians they donate to, it's impossible not to be dubious of these secret meetings.

This is a story that requires double skepticism. On one hand, skepticism of the weak association between autism and thimerosal, on the other skepticism of the industries and politicians who have worked together to hide information from regulators and to weaken those regulators when they might take dangerous actions.

In this case, those two strains of skepticism work in opposite directions. We have to be dubious of any claim that a drug in use for decades is responsible for a sudden rise in a disease at the tail end of its use. We want to be able to rely on the government experts to review those claims and to look out for our interests and to use their expertise in a specialized field to protect us. It's a failure of government that an assertion of safety must be taken with the same skepticism as the claims of people with financial interests.

Of course, this meeting was in 2000. Had the story broken then, I would have reacted differently because I trusted Bill Clinton's fundamental concern for the American public in a way that I don't trust the government today. And that's a problem, an illness of the government that is poisoning society at large.